Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up
| Autor: | Erling Hallström, Lars Rostgård Christensen, Stefanos Farfaras, Ninni Sernert, Jüri-Toomas Kartus |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Acromioplasty Physical Therapy Sports Therapy and Rehabilitation Subacromial decompression Osteoarthritis Lower risk Arthroplasty Rotator Cuff Injuries law.invention Arthroscopy 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law medicine Humans Orthopedics and Sports Medicine Rotator cuff Prospective Studies Physical Therapy Modalities Aged Ultrasonography 030222 orthopedics business.industry Rotator cuff injury 030229 sport sciences Evidence-based medicine Middle Aged Decompression Surgical medicine.disease Surgery medicine.anatomical_structure Shoulder Impingement Syndrome Female business Follow-Up Studies |
| Zdroj: | The American Journal of Sports Medicine. 46:1397-1407 |
| ISSN: | 1552-3365 0363-5465 |
| DOI: | 10.1177/0363546518755759 |
| Popis: | Background:The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated.Hypothesis/Purpose:The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS. The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Eighty-seven patients with SAIS were randomized to 3 groups: open acromioplasty (open surgery group [OSG]), arthroscopic acromioplasty (arthroscopic surgery group [ASG]), and nonsurgical treatment (physical therapy group [PTG]). The Constant score, the Watson and Sonnabend score, and the 36-Item Short Form Health Survey (SF-36) questionnaire were used as outcome measurements. Furthermore, bilateral ultrasound examinations were performed to detect rotator cuff ruptures and bilateral radiographs to detect OA. Sixty-six patients (76%) attended the clinical follow-up at least 10 years after the initial treatment.Results:The groups were demographically comparable at baseline. The Constant score improved significantly at follow-up for the OSG ( P = .003) and ASG ( P = .011), while no significant improvement was detected for the PTG. The OSG revealed a significant improvement versus the PTG at follow-up ( P = .011); otherwise, no significant differences were found. For the Watson and Sonnabend score, the OSG revealed a significant improvement in 13 of 14 questions. The corresponding finding was made for the ASG and PTG in 9 of 14 questions ( P = .14). According to ultrasound, 1 of 20 patients in the OSG had a full-thickness rotator cuff rupture on the index side. The corresponding finding was made for 1 of 18 patients in the ASG and 4 of 28 in the PTG ( P = .29). Per the radiographs, 3 of 20 patients in the OSG had moderate or severe OA in the index shoulder. The corresponding finding was made for 1 of 18 patients in the ASG and 0 of 28 in the PTG ( P = .12).Conclusion:After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA. |
| Databáze: | OpenAIRE |
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